Table A1: General Study Characteristics*.
| Service Details | HaH Details (Patient Follow-up) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Author, Year | Sample Size | Type of Service | Referral | Who Evaluates Patients | When are Patients Evaluated | Hours of Operation | Who | Frequency | After Hours Coverage | Types of Care Offered | Reasons for Ineligibility for HaH |
| Cotton et al, 2000 (21) | 81 | EDHaH | Hospital medical wards | Specialist respirator y nurse | Mornings after admission | Monday--Friday (hours NR) | Specialist respiratory nurse Changes in txt adjusted by respiratory med staff member discussed with nurse |
Morning after discharge then discretion of nurse | Patients’ GP | Assessment of pt progress based on subjective feelings, pulse, blood pressure, respiratory rate, temperature, oxygen saturation, chest auscultation, spirometry, sputum appearance, advice on use of meds. No additional services, such as social services or rehabilitation, were provided | Not resident of Glasgow, homeless (including hostel dwellers), unable to give informed consent, no access to telephone, patients required inpatient management or investigation for some other medical problem, patients with life-threatening respiratory failure (H* > 45 nM) at time of assessment, not waiting for results from investigational tests |
| Davies et al, 2000 (20) | 150 | AA | ED | Specialist nurses with additional COPD training | During operating hours | 7 d/wk, 8 AM – 6 PM | Specialist nurse | 2 visits/day for first 3 days then at discretion of the nurse | Agreement with district nurses | Social support if needed, nebulized ipratropium bromide, salbutamol with a compressor, oral prednisolone for 10 days, antibiotics for 10 days, additional services or testing performed NR | Personal history of asthma, marked use of accessory muscles, suspected underlying malignancy on chest x-ray film, pneumothorax or pneumonia, uncontrolled left ventricular failure, acute changes on ECG, requires full-time nursing care, requires IV therapy, FEV1 > 80% predicted, FEV1/FVC ratio < 70%, Mini-Mental State Score < 7, pulse rate > 100 beats/min, pH < 7.35, PaO2 < 7.3 kPa, PaCO2 > 8 kPa |
| Ojoo et al, 2002 (22) | 60 | EDHaH | Medical wards | NR | Morning after admission during hours of operation | Monday–Thursday 9 AM–5 PM | Respiratory outreach nurses | Daily | Telephone access through Medical Chest Unit direct line | Monitored treatment of patients and carried out patient and caregiver education and reassurance (limited information provided) | Concomitant medical conditions requiring admission, residence over 15 miles from hospital, complications of exacerbation (acidosis, cor pulmonale, acute changes on chest radiograph), newly diagnosed type 2 respiratory failure, social exclusion (discretionary and based on level of domiciliary support and performance status of pt) |
| Aimonino Ricauda et al, 2008 (19) | 104 | AA | ED† | NR | NR | 7 d/wk (hrs NR) | MDs and nurses‡
HaH team mtgs daily to discuss pt needs & pt care plans |
MD + nurse both visit daily in first few days, then nurse every day and MD every 2–3 days as needed | HaH staff available at all times | Blood tests, pulse oximetry, ECG, echo and Doppler US, oral and IV meds admission incl. antimicrobials and cytotoxic drugs, oxygen therapy, blood transfusion, central venous access, PT, OT, patient and caregiver education, advice on SC, nutrition, ADLs, energy conservation, meds, health maintenance, early recognition of exac., multidimensional geriatric assessment | Patients < 75 years, absence of family and social support, severe hypoxemia (PaO2 < 50 mmHg), severe acidosis or alkalosis (pH < 7.35 or > 7.55). Suspected pulmonary embolism, suspected MI, severe comorbid illness as defined by presence of need for hemodialysis, severe renal impairment (glomerular filtration rate < 20mL/min), cancer (except skin cancer), hepatic failure or severe dementia (Mini-Mental State Examination score <14) |
| Shepperd et al, 1998 (15;18) | 32§ | AA & EDHaH║ | GP or hospital ward | Unclear | NR | NR | Unclear, may include nurses and GPs | NR | NR | Observation, administration of drugs (including IV meds), rehabilitation including nursing, physiotherapy, occupational therapy, pathology, and speech therapy¶
Nursing care was available 24 hrs/d if needed |
Age > 60 yrs, home not suitable for hospital-at-home care (minimum requirements were hot and cold running water, indoor sanitary facilities, room for patient’s bed to be moved downstairs if needed), caregiver, if applicable, consented to trial |
| Skwarska et al, 2000 (6) | 184 | EDHaH | All admitted through ED but 99% pts referred to ED by GP, 1% by self-referral | Nurses provide tests then decision for inclusion made by respiratory team (i.e., consultant and registrar) | When admitted or morning after depending on hours of operation (present on weekends excluded) | Monday–Friday, 9 AM–5 PM | Acute respiratory assessment service nurses Weekly team mtgs with nurse & consultant in charge of trial to assess progress of pts |
Day after discharge then at 2–3 day intervals | NR | Monitored the need for patient treatment. No details provided about how level of care provided differed, whether any extra services were provided, and what the nurses could do at the home | Admitted on the weekend, required obligatory admission (impaired level of consciousness, acute confusion, new acute changes on radiograph, arterial pH < 7.35, coexistence of another medical condition, poor social circumstances which preclude home supported discharge |
Abbreviations: AA, admission avoidance hospital-at-home program; ADL, activities of daily living; d, day; ECG, electrocardiogram; echo, echograph; EDHaH, early discharge hospital-at-home program; ED, emergency department; exac, exacerbation; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GP, general practitioner; HaH, hospital-at-home; hr, hour; incl., including; IV, intravenous; MD, doctor; meds, medications; MI, myocardial infarction; mtgs, meetings; NR; not reported; OT, occupational therapy; PaCO2, partial pressure of carbon dioxide in arterial blood; PaO2, partial pressure of oxygen in arterial blood; pt, patient; PT, physiotherapy; SC, smoking cessation; txt, treatment; US, ultrasound; wk, week.
The hospital-at-home program in this study only recruited patients who presented to the ED, but the hospital-at-home program also receives direct GP referrals as well as hospital inpatients who are entered into early supported discharge programs.
The multidisciplinary team that runs the hospital-at-home program also includes a social worker, a counsellor, and 2 physiotherapists. However, it was unclear in the report whether they also visited patients.
The total sample size in the Shepperd et al trial was 538, but only 32 were COPD patients. Only the outcomes relevant for the COPD patient group included in the study are listed. (15;18)